Nursing for Childbearing Families: Exam 1

gestational age

age of pregnancy ranging between 1-40+ weeks

first trimester

1-12 weeks

second trimester

13-37 weeks

third trimester

27-40+ weeks

Gravidity/gravida

number of pregnancies

nulligravida

a client who has never been pregnant

primigravida

a client in their 1st pregnancy

multigravida

a client who has 2 or more pregnancies

Parity

number of pregnancies a client has carried to at least 20 weeks

NOT how many babies they have

(DOES NOT matter if baby was born alive or stillborn—> if pregnancy reached 20 weeks, it counts towards parity)

Nullipara

never had pregnancy reach 20 weeks

no pregnancy beyond viability

Primipara

one pregnancy reaching 20 or more weeks

Multipara

2 or more pregnancies reaching 20 or more weeks

viability

point at which fetus could potentially survive outside womb

what the definition of a presumptive sign of pregnancy

it is the weakest symptoms that suggest pregnancy; they are mostly subjective and indicate that the person MIGHT be pregnant

What are the presumptive signs of pregnancy?

amenorrhea

fatigue

nausea

vomiting

quickening

breast changes (enlarged montgomery’s gland, darkened areola)

urinary frequency

uterine enlargement

What is the definition of a probable sign of pregnancy?

signs that are moderate symptoms of pregnancy; they are mostly objective signs that indicate that pregnancy is most likely the cause but can still result from few other conditions

what are the probable signs of pregnancy

abdominal enlargement

hegar’s sign

chadwick’s sign

goodell’s sign

ballottetment

braxton hick’s contractions

positive pregnancy test

what is the definition of a positive sign of a pregnancy?

diagnostic for pregnancy; there is no other possibility except for pregnancy

What are the positive signs of pregnancy

fetal heart sounds

visualization of fetus by ultrasound

fetal movement (palpated by experienced examiner)

quickening

fetal movement palpated by the examiner

slight fluttering movements of the fetus felt by the client, usually between 16 to 20 weeks of gestation

Hegar’s sign

softening and compressibility of lower uterus

Chadwick’s sign

deep violet/bluish color of cervix and vaginal mucosa

Goodell’s sign

softening of cervical tip

Ballottetment

rebound of engaged fetus

braxton hicks contractions

false, mild, painless, irregular contractions

start in first semester but not FELT
began to feel in second semester

can be palpated as the uterus grows

expected fetal heart rate

110-116 bpm

what occurs at 12 weeks of pregnancy in regards to uterine size

it is considered an abdominal organ

fundus becomes palpable just above the pubic symphysis “show” d/t enlarging abd (uterus is pushing up)

what is a fundal height?

measure of the top of the pubic symphysis to the top of the uterus after 12 weeks of pregnancy

Where is the fundal height at 12 weeks

at the pubic symphisis

where is the fundal height at 16 weeks?

halfway between the pubic symphysis and the umbilicus

where is the fundal height at 20 weeks

at the umbilicus

how much does the fundal height grow after 20 weeks

1 cm growth/week

20 weeks=20cm

what is the most important thing to consider when trending fundal height

that growth over time is the most important

What are physiologic breast changes during pregnancy

increased glandular tissue

breast is less soft/fatty and becomes denser

areola darkens

enlarged Montgomery’s gland

breast tenderness, sensitivity, and tingling

cardiac output increases by ___ during pregnancy

40% and the heart hypertrophies during pregnancy

respiratory physiology of pregnancy

increased o2 demands, diaphragm is moved up by uterus, chest and lungs expand, SOB is common, but there is no changes in RR

Renal physiology of pregnancy

urinary frequency

dilation of the the kidneys and ureters increases risk of UTI

Gastrointestinal physiology of pregnancy

constipation and bloatingwha

causes of increased vascularity d/t pregnancy

gingivitis, hemorrhoids, nasal stuffiness, epistaxis

where can varicose veins be found in pregnancy

legs and/or vulva

What is chloasma (melasma)

physiologic pigmentation change during pregnancy

NOT a rash

fades after pregnancy

What do pregnancy tests measure

hcG

what is hCG

a hormone produced by the placenta during pregnancy

Urine vs Blood tests when detecting hCG

Urine tests are less sensitive, requiring more hCG to determine a positive pregnancy. Whereas a blood test is much more sensitive, requiring less hCG to detect a positive pregnancy.

what may increased hCG indicate

pregnancy

fetal anomaly

what may too little hCG indicate

a miscarriage

fetal anomaly

Pt education about home pregnancy test

pee on stick or clean catch in cup

first morning urine is best

when is the earliest positive pregnancy test detectable

1 week before period is due

what does a false negative pregnancy test indicate

hCG is present, but NOT detected

may indicate the pregnancy is too early in gestation (not enough hCG), potentially ectopic, test error

what does a false positive pregnancy test indicate

The test is positive, but there is no pregnancy

could be gestational trophic disease (not enough hCG), miscarriage/abortion, rare antibodies, or genetic causes

when is the bladder considered an abdominal organ

NEVER unless there is serious and major urinary retention

supine hypotension syndrome

when the mother lays on her back, the growing uterus places pressure on the inferior vena cava (the large vein responsible for bringing blood back to the heart), resulting in a sudden drop in blood pressure

present at 20 weeks

low BP and high HR (compensation)

low maternal BP results in low BF to placenta and O2 to the fetus

When should clients schedule a prenatal visit

first visit at 4-10 weeks

every 4 weeks until 28 weeks

every 2 weeks from 28-36 weeks

every week from 36 weeks until delivery

What is done during the first prenatal visit

full health history, physical exam, determine EDB, labs, depending on gestational age (fetal heart rate, fundal height, fetal movement, leopold’s maneuvers), current symptoms, danger signs, education

What is a taratogen

anything that could cause birth defects

When is the fetus most at risk for developing birth defects?

before 9 weeks

common taratogens

nicotine, alcohol, cannabis, opioids, cocaine, meth, folic acid deficiency, high body temp, poor glycemic control, radiation, STIs, some viral/bacterial infections, caffeine (>200mg)

Lab test (purpose, timing, associated complication): blood type and Rh factor

purpose: avoid alloimmunization, in case transfusion needed

timing: first visit

complications: alloimmunization, hemorrhage

Lab test (purpose, timing, associated complication): CBC, differential, H&H

Purpose: detect infection, anemia

timing: first visit

complications: infection/anemia

Lab test (purpose, timing, associated complication): rubella titer

purpose: Rubella immunity

timing: first visit

complications: risk of birth defects, congenital rubella if infected during pregnancy

Lab test (purpose, timing, associated complication): Hepatitis B screening

purpose: hepatitis B carrier

timing: first visit

complication: fetal transmission

Lab test (purpose, timing, associated complication): vaginal cultures

purpose: gonorrhea, chlamydia

timing: first visit

complications: risk newborn blindness

Lab test (purpose, timing, associated complication): VDRL

purpose: syphilis

timing: first visit

complication: congenital syphilis

Lab test (purpose, timing, associated complication): HIV

timing: first visit

complications: fetal transmission

Lab test (purpose, timing, associated complication): urinalysis

purpose: glucose, ketones, WBCs, protein

timing: every visit

complications: gestational diabetes, dehydration, infection, preeclampsia

Lab test (purpose, timing, associated complication): glucose tolerance testing

purpose: Identify gestational diabetes

timing: 28 weeks

complications: gestational diabetes

Lab test (purpose, timing, associated complication): group b strep

purpose: Prevent infection by treating mother

timing: 35-37 weeks

complications: newborn sepsis

What is a pregnant Rh negative patient at risk for

alloimmunization

What can result from alloimmunization of Rh negative patient carrying Rh positive fetus?

fetal hemolytic anemia, brain damage, death. Alloimmunization can also occur with blood transfusions

what is Rh immune globulin (RhoGAM) made from

human plasma

dosing of RhoGAM

300mcg IM at 26-30 weeks and 300mcg IM at birth IF newborn is Rh+

when should RhoGAM be administered

BEFORE alloimmunization

what is an indirect coombs test

a screening test for alloimmunization, Rh, or other antibodies

Aneuploids

trisomy, 21, 18, and 13t

trisomy 21

down syndrome

trisomy 13

Patau

trisomy 18

edwards syndrome

neural tube defects

spina bifida, anencephaly

Screenings for Aneuploidy and NTDs (test, timing, sample, and detection): non-invasive prenatal testing (NIPT)

timing: 10+ weeks

sample: Maternal blood, cell-free DNA (cfDNA)

detection: Trisomy 21, 18, 13, some others

Screenings for Aneuploidy and NTDs (test, timing, sample, and detection): 1st trimester combined test

timing: 10-14 weeks

sample: maternal blood + ultrasound for nuchal translucency

detection: trisomy 21, 18, 13

Screenings for Aneuploidy and NTDs (test, timing, sample, and detection): “quad marker” screening

timing: 15-22 weeks

sample: maternal blood

detection: trisomy 21, 18, 13, and NTDs

Screenings for Aneuploidy and NTDs (test, timing, sample, and detection): Maternal alpha-fetoprotein

timing: 16-18 weeks

sample: maternal blood

detection:NTDs, trisomy 21

Screenings for Aneuploidy and NTDs (test, timing, sample, and detection): 2nd semester ultrasound

timing: 18-22 weeks

sample: ultrasound

detection: anatomic abnormalities

What immunizations are pertinent for pregnancy

rubella, varicella, influenza, COVID 19, hepatitis B

Antibody titers must be assessed to determine antibody levels for what diseases

rubella and varicella

do you give Hep B vaccines to pregnant women?

if mother has not already received it, yes

Antibody titer and immunization administration timing: Tdap

antibody titer: NO

Timing: administer vaccine at 27-35 weeks

Antibody titer and immunization administration timing: influenza

antibody titer: NO

timing: flu season

Antibody titer and immunization administration timing: rubella and varicella

antibody titer: YES
timing: postpartum ONLY live vaccine is contraindicated

Antibody titer and immunization administration timing: Covid

antibody titer: NO

timing: anytime

what can happen if there is low fetal movement during pregnancy?

hypoxia and increased risk for poor outcomes (stillbirths)

instructions for activity/kick counts

2 to 3 times a day, spend 2 hours counting kicks (movement), contact provider if less than 3 kicks and hour or none for 12 hours

pregnancy discomforts

nausea and vomiting, pyrosis (heartburn), constipation, hemorrhoids, gingivitis, nasal stuffiness, epistaxis, urinary frequency, UTI, varicose veins, lower extremity edema, breast tenderness, fatigue, braxton hicks contractions, supine hypotension, backaches, leg craps, mild SOB

discomfort (trimester and management): nausea & vomiting

trimester: 1st or longer

management: avoid empty stomach, dry carbohydrates in the morning, eat small amounts frequently, avoid spicy/greasy/gassy foods.

discomfort (trimester and management): pyrosis

trimester: 2nd and 3rd

management: small, frequent meals, avoid gassy foods, avoid over-full or empty stomach, only take antacids with provider approval.

discomfort (trimester and management): constipation/hemorrhoids

trimester: 2nd and third

management: 8-10glasses of water/day, high fiber foods, regular exercise, no stool softener w/out contacting provider, sitz bath

discomfort (trimester and management): gingivitis, nasal stuffiness, epistaxis

trimester: throughout pregnancy

management: good dental hygiene, soft toothbrush, gentle brushing, nasal rinses/saline drops, humidifier

discomfort (trimester and management): urinary frequency

timing: 1st and 3rd trimester

managemntetn: void frequently, avoid caffeine, limit fluids near bedtime, pads, kegel exercises

discomfort (trimester and management): urinary tract infections

trimester: 1st and 3rd

management: good hygiene, 8-10 glasses of water/day, cotton underwear, avoid tight pants, urinate before and after intercourse, report painful urination

discomfort (trimester and management): varicose veins, lower extremity edema

trimester: 2nd and 3rd

management: rest w/ elevated legs and hips, avoid constricting clothes, support hose, avoid sitting/standing in one position for too long, sleep in side lying/lateral position, moderate exercise